自体骨髓移植治疗股骨头无菌性坏死

An experimental study on the treatment of osteonecrosis of the femoral head with autologous bone marrow grafting

目的探讨自体骨髓移植治疗股骨头坏死的疗效及其作用机制。方法选用成年新西兰雄兔60只，造模后随机分为A、B、C三组。左侧股骨头作为对照组，不予处理，右侧为实验组。A组用米托蒽蓖按0．1mg／kg量在数字减影型X射线机（DSA）导视下注入右侧股骨头内；B组在DSA下直接注人自体骨髓1ml；C组先予以化疗（方法同A组），72h后注入自体骨髓1ml。4个月后处死所有动物，取股骨头进行组织病理学及电镜观察。结果A、B组内左右股骨头对比破骨细胞坏死数差异无统计学意义（P〉0．05），而C组左右股骨头坏死数分别为40．60±4．11、21．33±2．16，差异有统计学意义（P〈0．05）。C实验组镜下见大部分骨细胞结构清晰、完整，偶见坏死。结论局部化疗＋自体骨髓移植在细胞水平上对股骨头无菌性坏死具有一定的治疗作用。

Objective To investigate the effectiveness and mechanism of transplantation of autologous bone marrow in treating femoral head necrosis. Methods Sixty New Zealand rabbits were randomly divided into groups A, B, and C after establishment of the models of femoral head necrosis. The left femoral head served as the control one, and the right as the experimental group. The mitoxantrone （0. 1 mg/kg） with the help of DSA was injected into the femoral head of group A. One ml autologous bone marrow was injected into the femoral head of group B. In group C,mitoxantrone （0.1 mg/kg） was injected,and 72 h later, 1 ml autologous bone marrow was injected. Four months later, all rabbits were killed, and the femoral heads were removed and observed histologically and electron microscopically. Results The number of necrotic osteoclasts in groups A and B showed no significant difference （P 〉 0. 05 ）, ande in group C, the number of necrotic femoral heads at the left and right sides was 40.60 ± 4.11 and 21.33 ± 2.16 respectively （P 〈0.05）. At the experimental side of group C,the structure of majority bone cells was clear and intact, and necrosis was occasionally seen. Conclusion At the cellular level, local chemotherapy and autologous hematopoietic stem cell transplantation had certain effectiveness for aseptic necrosis of the femoral head.